The tipping point came nearly seven years ago when 82-year-old Evelyn was still living alone in her Georgia home. She was in good shape physically, still sharp mentally, and able to manage her daily tasks. But after a health scare, her family made a "nonnegotiable" decision they hoped would help the grandmother of eight stay independent even longer. They installed a WiFi camera inside her home.
It took some convincing. Evelyn told her daughter Terri Davis, somewhat jokingly, "I think you're putting in a spy camera."
"I assured her we had lots to do with our busy lives and wouldn't just be watching her," said Davis, 65. "We're just going to peek in a few times a day like in the morning to make sure she got up, that the night was okay."
Now Evelyn, who declined to use her last name, for privacy, is in an assisted-living center. The camera is still with her, and she also wears a medical alert button around her neck. Nearing 90, Evelyn is tech savvy enough to text and check Facebook and Instagram on her iPhone, and she knows how to unplug the camera when she is not in the mood to be seen.
Smart home technology has long been used by caretakers to monitor older adults. Cameras you can watch from anywhere are among the most common, but there are also sensors for detecting movement, remote monitoring for climate controls and power outlets as well as voice-activated screens and speakers. With the right setup, someone can see whether a relative has fallen or let them know they left the stove on.
On the surface the benefits of home and health monitoring technology seem obvious. A flow of information about the older person can put a caretaker at ease and help keep track of physical or cognitive decline. It is a way to extend the amount of time they are able live in their own homes before moving to someplace like a retirement or nursing home.
But the devices, many of which grew out of security and surveillance systems, can take privacy and control away from a population that is less likely to know how to manage the technology themselves. The idea of using tech to help people as they age is not a problem, experts say, but how it's designed, used and communicated can be. Done wrong or without consent, it is one-way surveillance that can lead to neglect. Done right, it can help aging people be more independent.
"There has not been any company that has embraced really reciprocal, empowering caregiver-centric technologies," said L. Jean Camp, a professor at the Indiana University School of Informatics and Computing who has researched tech for the elderly.
One necessary ingredient for these kinds of devices is two-way communication, Camp says. It is confirmation that someone is on the other side of a video feed or app update, making it a conversation instead of one party watching the other.
The tech industry is pushing ahead with more products specifically for caretaking. In the past year alone, two tech companies announced new monitoring products aimed at aging adults that try to move away from the most invasive setups. Amazon previewed Alexa Together, a $20-a-month service that lets caretakers know when connected devices are being used and has 24/7 emergency response that can be called over an Alexa device. Apple added a feature that lets people share health trends such as changes in daily activity, sleep patterns or heart rate from an iPhone or Apple Watch with family members or doctors.
Seniors have also embraced connected-home tech for themselves. According to the research firm Forrester, smart speakers such as Amazon's Echo are the most popular types of connected devices for people 60 and older, followed by Internet-connected thermostats, voice-activated displays such as the Google Nest Hub and doorbells with WiFi cameras or audio. Aside from privacy issues, Internet-connected devices are also a security worry. Many are stuffed with insecure software and require regular updates and password changes so they are not vulnerable to breaches.
Florence Macauley is the founder of AgeWise Home and a specialist who updates living spaces for people who are elderly, experience dementia or are disabled. She says she does not focus on technology when modifying homes or training caregivers for older residents. Though she is often hired by caretakers such as adult children, she considers the person living in the home as her client.
"I make sure they [the elderly] understand that they are in charge, because a lot of the tech that is brought into the homes is not at the request of who is being watched," Macauley said.
She has also seen first hand how families can use technology as a replacement for in-person caretaking.
"One client told me, 'My kids just watch me on the camera but they don't come visit me,'" Macauley said. "I know how much it bothered him. He made me wave to the camera." The client's children all lived close by.
Being there for someone virtually is not the same as being there physically, experts say. Having a support system can be the difference between a long hospital or nursing home stay and recovering at home, according to a new study from the University of California at San Francisco. Researchers looked at data for people 65 and older over the course of nine years and found that having a friend or family member who could help them in person after a health crisis - for example, staying overnight for a couple of days after pneumonia - lowered the chances of a lengthy hospital stay.
"I found that we often admit people to the hospital, not just because of their medical needs but also because of their social needs," said the lead author of the study, Sachin Shah, an assistant professor of medicine at UCSF. "What people often need is just physical help, like rides to the doctor's office and help with activities of daily living: eating, bathing, dressing, toileting."
They are the kinds of tasks that require in-person assistance, experts say, not a roving social robot with a periscope camera, wide eyes and a 24/7 connection to emergency operators.
Amazon Astro is a new $1,000 robot outfitted with cameras and microphones that can act like a companion or a sentinel, roaming your home to keep an eye on things. It will work with Amazon's Alexa Together service, but caretakers do not have access to the cameras or mics unless they set it up themselves under their own account. Amazon added controls so the person being monitored can turn it off by calling customer service or going into Alexa settings. However, experts warn that a small mobile robot is a tripping hazard for older people who may not hear or see it, and for whom a simple fall can be serious. Amazon says the robot makes sounds and uses sensors to avoid collisions.
The Alexa Together service will give caretakers a feed of what a person is up to based on things such as when they first used Alexa that day, triggered a motion sensor or turned on a light. An adult child could also set a reminder on their parent's Echo speaker such as "Take a walk" and do some remote tech support. The robot and service are not out yet, but people can sign up to find out when they are released. (Amazon founder Jeff Bezos owns The Washington Post.)
"We designed Alexa Together to give both the care recipient and caregiver peace of mind, without compromising privacy," said Beatrice Geoffrin, director for Amazon Alexa. "For example, in order to use Alexa Together, the care recipient has to first approve the connection with their caregiver, and can end the connection at any time. Once approved, the caregiver only sees a high level summary of activities like general requests to play entertainment."
Who has control is key when setting up a connected home for an older adult. Apple's Health sharing feature is set up entirely on the user's device and pushes updates to the caretaker only when there is a change, such as a drop in physical activity, though they can check the app anytime. While the person sharing the data has control (and can disable sharing at anytime), devices such as smartwatches are often set up and managed by a more tech-savvy relative. Technology is frequently harder for older adults to learn and use, giving them less control even when the settings are in front of them. Some tech is designed specifically to work around that, such as Amazon's Drop In feature for starting a video call remotely.
There is an imbalance of power that often exists between the elderly and their caretakers when it comes to technological know how. In the worst-case scenario, it can also play a role in elder abuse, whether it is financial, physical or emotional, experts say.
Laura Mosqueda, a professor of family medicine and geriatrics and co-director of the National Center on Elder Abuse, says home technology can help catch elder abuse as well as contribute to it. She recently saw a video a family took using a WiFi camera that caught a paid caretaker hitting their loved one. But she is also worried that tech will be added to homes without conversations with the people being monitored about what it means.
"We do need to have this conversation with older adults: 'Is this okay with you?'" Mosqueda said. "Are we giving just peace of mind to the family or is this actually what the older adult wants?"
Just sharing something simple such as daily activity could lead to a family member nagging their elderly mother to get up and move around more. Being old does not mean you lose your rights, Mosqueda says.
When done right, automating tasks such as medication reminders, turning down heaters remotely, tracking when someone has fallen or seeing who is at mom's door has the potential to improve relationships between caregivers and the person they are helping, experts say. It can help with the more administrative side of things, checking in on health and movement. That leaves more time for connecting and conversations and makes in-person visits an opportunity for quality time.
Not everyone has the same fears about privacy or feels that it is something to be worried about. Susan Spring is a healthy, retired 78-year-old who still lives on her own in Schenectady, N.Y., but says she would not object if one of her sons wanted a camera in her home to check in. She would just prefer a heads-up.
"I think it would be a lot of fun," Spring said. "But I'd like something where if they were tuning in I'd know it and say, 'Hi.'"